2011-11-11T08:48:56-06:00 2010-12-31 990 2010-01-01 560554230 PRESBYTERIAN HOSPITAL PRES 3367182803 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 FRED HARGETT 3367182003 2011-11-10 2010 2016-03-07 17:11:31Z MARK BILLINGS 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 738594434 0 X WWW.PRESBYTERIAN.ORG X 1903 NC SEE SCHEDULE O 14 11 5600 739 22654 0 1970075 2808695 672826567 715378410 25667 -202611 13913977 19488890 688736286 737473384 963364 1064408 0 0 273305619 269638886 0 0 0 345477287 358562204 619746270 629265498 68990016 108207886 511341515 598721752 54294151 44412397 457047364 554309355 X SEE SCHEDULE O 0 0 530458810 1064408 730794302 THE PRESBYTERIAN HOSPITAL (PH) AND PRESBYTERIAN HOSPITAL HUNTERSVILLE (PHH) EXIST TO PROMOTE THE HEALTH OF THE INHABITANTS OF THE CHARLOTTE-MECKLENBURG COUNTY AREA REGARDLESS OF THE PATIENT'S ABILITY TO PAY. DURING 2010, PH HAD 531 LICENSED BEDS. THERE WERE 175,709 PATIENT DAYS, WITH AN AVERAGE LENGTH OF STAY OF 5.67 DAYS, AND AN AVERAGE DAILY CENSUS OF 481. THERE WERE 30,977 DISCHARGES, 22,226 INPATIENT AND OUTPATIENT SURGERIES, 138,279 OUTPATIENT ENCOUNTERS AND 81,126 EMERGENCY DEPARTMENT VISITS. (CONTINUED ON SCHEDULE O) 530458810 1 1 0 1 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 1 0 1 5600 1 1 1 0 0 0 0 1 1 0 0 0 0 X 14 11 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 0 0 1 1 1 1 NC X KAREN DAUGHERTY 3367182803 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 X ARMATOCARL STEVEN 60.00 X 0 1238583 1433648 BILLINGSDERRICK MARK 60.00 X X 708128 0 307765 BLAKE MD PAUL 2.00 X 0 0 0 CURETON JESSE 2.00 X X 0 0 0 DAVIES PHD PHD PAMELA LEWIS 2.00 X 0 0 0 FLETCHER MDSIDNEY 2.00 X 0 20029 0 FOX ANTHONY 2.00 X 0 0 0 GALLAGHER ARTHUR J 2.00 X X 0 0 0 JONES BRUCE 2.00 X 0 0 0 LYLES VI ALEXANDER 2.00 X X 0 0 0 PALERMO JAMES R 2.00 X X 0 0 0 POSTON MD WILLIAM K 2.00 X 0 0 0 STOWE D HARDING 2.00 X 0 0 0 STROUP III PAUL A 2.00 X 0 0 0 WILLIAMS DAN R 2.00 X 0 0 0 STILLERMANSHELLI STOKER 2.00 X 0 216511 58111 WALSHBETSY JEAN 2.00 X 0 261214 86415 BLACKMONTANYA S 60.00 X 214162 0 88056 VANCEAMY SUSAN 60.00 X 423271 0 221982 VINCENTPAULA ROLLINS 60.00 X 477139 0 233010 ZWENGTHOMAS NELSON 60.00 X 629302 0 307658 CAMPBELLPATRICIA T 40.00 X 219944 0 84856 DAVISTIMOTHY B 40.00 X 222364 0 24629 ELMORELARRY C 40.00 X 219297 0 26642 REILINGRICHARD B 40.00 X 336623 0 104378 SHOAF JREDWIN H 40.00 X 225068 0 58955 BOGGSLYNN I 0.00 X 128173 0 235 3803471 1736337 3036340 170 1 1 0 RODGERS BUILDERS INC PO BOX 18446 CHARLOTTE NC 28218 CONTRACTOR 34377335 MORRISON MANAGEMENT PO 102289 ATLANTA GA 30368 FOOD SERVICES 10209565 AMERICAN RED CROSS PO 905890 CHARLOTTE NC 28290 BLOOD PROCESSING 4328119 CARILION LABS LLC 10320 FELD FARM LN CHARLOTTE NC 28260 LAB SERVICES 2608402 COMMUNITY BLOOD CENTER OF CAROLINAS CHARLOTTE NC 28209 BLOOD PROCESSING 2260246 58 2482872 325823 2808695 NET PATIENT SERVICE RE 621110 715378410 715378410 715378410 65858 65858 14145 14145 14145 14145 479982 748451 -268469 -268469 -268469 449700 372599 77101 77101 MISCELLANEOUS 900099 6140385 6140385 PHARMACY 446110 2434349 2411695 22654 CHILD CARE DEVELOPMENT 624410 1613183 1613183 9209727 6863812 2345915 19397644 737473384 730794302 22654 3847733 1034408 1034408 30000 30000 2452002 2452002 128173 128173 213467680 205351053 8116627 10546309 10139221 407088 27346856 26291267 1055589 15697866 15091928 605938 989888 989888 21703922 20866151 837771 4449257 4277516 171741 9111601 8759893 351708 655941 630622 25319 11601365 11153552 447813 274858 264248 10610 332283 319457 12826 7842297 7539584 302713 27194285 26144586 1049699 1120715 1077455 43260 SUPPLIES 110762877 106487430 4275447 CORPORATE ALLOCATION 76060957 76060957 BAD DEBT 30239650 30239650 PHYSICIAN SERVICES 18359145 18359145 EQUIPMENT RENTAL & MAIN 14803994 14232560 571434 23059169 22169084 890085 629265498 530458810 98806688 0 348320 994438 88815683 79964548 7350143 9526433 10823956 10147958 1056031 1084813 637266614 347297727 275379352 289968887 2289425 2354310 125278605 204680365 511341515 598721752 29741506 29475944 9581075 5596706 14971570 9339747 54294151 44412397 X 457036633 554298624 10731 10731 457047364 554309355 511341515 598721752 X 108207886 -10945895 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 63543 63543 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: DUES PAID TO CERTAIN ORGANIZATIONS WHICH INCLUDE A PORTION RELATED TO LOBBYING ACTIVITIES. 10731 10731 10731 10731 1.00000 0 0 7138673 7138673 307118144 162313972 144804172 6261988 5478428 783560 210243341 164000524 46242817 106504468 15504803 90999665 289968887 DUE FROM AFFILIATES 150555849 INVESTMENT IN AFFILIATES 54124516 204680365 0 OTHER LIABILITIES 6829517 THIRD PARTY PAYMENT ADJUSTMENT 2510230 9339747 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: INTENDED USES FOR ENDOWMENT FUNDS THE ENDOWMENT FUNDS INTENDED USE IS FOR EQUIPMENT AND PROGRAMS TO BETTER SERVE THE HOSPITAL'S PATIENTS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: LIABILITY UNDER FIN 48 (ASC 740) FOOTNOTE THE AUDIT FOR NOVANT HEALTH AND ITS AFFILIATES IS PREPARED ON A CONSOLIDATED BASIS. FOR THE YEARS ENDED DECEMBER 31, 2010 AND 2009, THE COMPANY WAS REQUIRED TO EVALUATE UNCERTAIN TAX POSITIONS. THIS EVALUATION INCLUDES A QUANTIFICATION OF TAX RISK IN AREAS SUCH AS UNRELATED BUSINESS TAXABLE INCOME AND THE TAXATION OF OUR FOR-PROFIT SUBSIDIARIES. THIS EVALUATION DID NOT HAVE A MATERIAL EFFECT ON THE COMPANY'S STATEMENT OF OPERATIONS FOR THE YEARS ENDED DECEMBER 31, 2010 AND 2009. FUNDRAISERS 449700 449700 372599 449700 449700 372599 372599 77101 1 1 X 1 X 300.000000000000 1 X 1 1 0 1 1 26376193 26376193 0.04190 82151677 65498748 16652929 0.02670 10195536 7462902 2732634 0.00440 118723406 72961650 45761756 0.07300 19468778 4791924 14676854 0.02330 46404684 38261961 8142723 0.01290 1161407 535007 626400 0.00100 644274 644274 0.00100 67679143 43588892 24090251 0.03820 186402549 116550542 69852007 0.11120 1 9907796 0 154325544 155472888 -1147344 X 1 1 1 SOUTHPARK SURGERY CENTER HEALTHCARE 0.60000 0.40000 2 1 PRESBYTERIAN HOSPITAL

200 HAWTHORNE LANE CHARLOTTE NC 28204

X X X X 2 PRESBYTERIAN HOSPITAL HUNTERSVILLE

10030 GILEAD RD HUNTERSVILLE NC 28078

X X X NA 1 0 0 0 0 0 0 0 0 0 0 0 4 MIDTOWN SURGERY CENTER

1918 RANDOLPH ROAD CHARLOTTE NC 28207

AMBULATORY SURGERY CENTER PRESBYTERIAN INTERNAL MEDICINE CLINIC

1918 RANDOLPH ROAD SUITE 350 CHARLOTTE NC 28207

PHYSICIAN CLINIC CHARLOTTE INTERNAL MEDICINE

1701 ABBEY PLACE CHARLOTTE NC 28209

PHYSICIAN CLINIC PRESBYTERIAN PULMONARY & CRITICAL CARE

1900 RANDOLPH ROAD SUITE 216 CHARLOTTE NC 28207

PHYSICIAN CLINIC PART I, LINE 6A: THE ORGANIZATION IS PART OF THE NOVANT HEALTH CARE SYSTEM AND THE COMMUNITY BENEFIT REPORT IS PREPARED BY A RELATED ORGANIZATION. NOVANT HEALTH, INC. PRODUCES ITS OWN COMMUNITY BENEFIT REPORT, WHICH REPRESENTS THE HEALTH SYSTEM AS A WHOLE AND CAN BE FOUND AT HTTP://WWW.NOVANTHEALTH.ORG/DOWNLOADS/FINANCIAL_INFO/2010_COMMUNITY_INVOLVEMENT.PDF. PLEASE NOTE THAT THE NUMERIC INFORMATION IN THIS REPORT IS NOT BASED UPON THE FORM 990, SCHEDULE H CRITERIA, BUT RATHER IT HAS BEEN PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HOSPITAL ASSOCIATION REPORTING GUIDELINES. PART I, LINE 7: COSTS REPORTED IN THE TABLE OF CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS AMOUNTS ARE CALCULATED USING AN ENTITY SPECIFIC COST TO CHARGE RATIO BASED ON WORKSHEET 2 (RCC). PART I, L7 COL(F): THE AMOUNT OF BAD DEBT REMOVED FROM TOTAL EXPENSES (DENOMINATOR) WAS $30,239,650. PART II: ALTHOUGH PART II FOR SCHEDULE H HAS BEEN LEFT BLANK, THE ORGANIZATION DOES ENGAGE IN MANY COMMUNITY BUILDING ACTIVITIES, WHICH SUPPORT AND STRENGTHEN THE COMMUNITY IT SERVES. THESE ACTIVITIES ARE IMPORTANT TO THE ORGANIZATION'S MISSION TO IMPROVE THE HEALTH OF THE COMMUNITY. HOWEVER, THE ORGANIZATION HAS NOT TRADITIONALLY MAINTAINED AN INFRASTRUCTURE TO TRACK, MONITOR AND REPORT THESE ACTIVITIES. THE ORGANIZATION IS PART OF THE NOVANT HEALTH CARE SYSTEM, WHICH HAS A COMMUNITY BENEFIT COMMITTEE. THE COMMUNITY BENEFIT COMMITTEE IS CURRENTLY IN THE PROCESS OF ESTABLISHING THE APPROPRIATE INTERNAL MECHANISMS TO TRACK, MONITOR AND REPORT THESE ACTIVITIES. THE ORGANIZATION IS COMMITTED TO CONTINUING TO PROVIDE THE COMMUNITY BUILDING ACTIVITIES NECESSARY TO MAINTAIN A HEALTHY, PRODUCTIVE AND VIABLE COMMUNITY. PART III, LINE 4: THE ORGANIZATION'S BAD DEBT EXPENSE (AT COST)ON LINE 2 IS CALCULATED USING THE SAME METHODOLOGY AS CHARITY CARE AND OTHER COMMUNITY BENEFITS USING AN ENTITY SPECIFIC COST TO CHARGE RATIO (RCC).BAD DEBT EXPENSE ONLY REPRESENTS ACCOUNTS FOR WHICH COLLECTION EFFORTS HAVE BEEN MADE BUT NO PAYMENTS HAVE BEEN RECEIVED. DISCOUNTS ARE RECORDED AS EITHER CONTRACTUALS (FOR PATIENTS WHO DO NOT QUALIFY FOR CHARITY) OR AS CHARITY (FOR PATIENTS WHO DO QUALIFY FOR CHARITY). THE TEXT OF THE NOVANT HEALTH, INC. CONSOLIDATED FINANCIAL STATEMENTS READS: "THE PROVISION FOR BAD DEBTS IS DETERMINED BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, BUSINESS AND ECONOMIC CONDITIONS, THE AGE OF THE ACCOUNTS, TRENDS IN FEDERAL AND STATE GOVERNMENTAL HEALTH CARE COVERAGE AND OTHER COLLECTION INDICATORS." PART III, LINE 8: THE METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT AS REFLECTED IN THE AMOUNT REPORTED IN PART III, LINE 6 IS DETERMINED BY FOLLOWING THE MEDICARE PRINCIPLES OF ALLOWABLE COSTS. COST FOR THE OVERHEAD DEPARTMENTS ARE STEPPED DOWN TO THE REMAINING COST CENTERS BASED ON STATISTICS FOR EACH OVERHEAD COST CENTER. ONCE THE STEP-DOWN PROCESS IS COMPLETE, A RATIO OF COST TO CHARGES IS DEVELOPED FOR EACH COST CENTER. THE RCC IS THEN APPLIED TO THE MEDICARE REVENUE BY COST CENTER AND TOTALED.IT SHOULD BE NOTED THAT THE MEDICARE COST REPORTS DO NOT ADDRESS ANY MANAGED CARE MEDICARE REVENUES, COSTS, OR RELATED SHORTFALL. THE TOTAL REVENUES REPORTED AS RECEIVED FROM MEDICARE IN LINE 5 OF SECTION B ARE ONLY REPRESENTATIVE OF MEDICARE FEE FOR SERVICE PAYMENTS RECEIVED. THE ALLOWABLE COSTS ON LINE 6 ARE SIGNIFICANTLY LOWER THAN THE ACTUAL EXPENDITURES. AS SUCH, THE SHORTFALL IS UNDERESTIMATED. EVERY HOSPITAL TREATS MEDICARE PATIENTS. SOME HOSPITALS ARE LOCATED IN HIGH MEDICARE POPULATION AREAS OR OFFER SERVICES DISPROPORTIONATELY USED BY MEDICARE PATIENTS. MEDICARE RATES AND NUMBERS OF MEDICARE PATIENTS ARE NOT NEGOTIATED. AS REIMBURSEMENT RATES DECLINE RELATIVE TO COSTS OF CARE, HOSPITALS CONTINUE TO SERVE THE MEDICARE POPULATION. WITHOUT THIS SERVICE THESE PATIENTS WOULD BECOME AN OBLIGATION TO THE GOVERNMENT. ANY UNREIMBURSED COSTS OF THIS CARE ARE A COMMUNITY BENEFIT PROVIDED BY THE HOSPITAL TO THE COMMUNITY AND GOVERNMENT. PART III, LINE 9B: IN ADDITION TO OUR FINANCIAL COUNSELING PROCESSES USED TO IDENTIFY CHARITY CARE PATIENTS, OUR COLLECTIONS PROCESSES WITHIN OUR BUSINESS OFFICES ALSO HELP IDENTIFY PATIENTS WHO ARE ALREADY ELIGIBLE FOR CHARITY OR WHO MAY BE ELIGIBLE BASED ON THEIR STATUS WITHIN THE FEDERAL POVERTY GUIDELINES ("FPG"). WE UTILIZE PREVIOUSLY SUBMITTED PATIENT DOCUMENTATION AND CREDIT AGENCY REPORTED STATUS FOR DETERMINATION. SUPPORTING DOCUMENTS ARE VALID 6 MONTHS FROM THE DATE OF SUBMISSION. OUR POLICIES ARE CONSIDERED FLUID AND ARE UPDATED FREQUENTLY BASED ON LOCAL AND NATIONAL MARKET STANDARDS AND NATIONAL ECONOMIC CONDITIONS. ANY UPDATES TO OUR POLICIES REQUIRE MULTI-LEVEL LEADERSHIP APPROVAL AND ARE ULTIMATELY APPROVED BY THE NOVANT EXECUTIVE TEAM. PART VI, LINE 2: NEEDS ASSESSMENTTHE ORGANIZATION IS PART OF THE NOVANT HEALTH CARE SYSTEM, WHICH HAS A COMMUNITY BENEFIT COMMITTEE. THE COMMUNITY BENEFIT COMMITTEE IS RESPONSIBLE FOR ASSISTING THE HOSPITALS WITHIN THE HEALTH CARE SYSTEM WITH PREPARING COMMUNITY NEEDS ASSESSMENTS. THE COMMUNITY BENEFIT COMMITTEE IS MADE OF INDIVIDUALS REPRESENTING CORPORATE-WIDE DEPARTMENTS, SUCH AS COMMUNITY RELATIONS, LEGAL, TAX, INTERNAL AUDIT, MARKETING/COMMUNICATIONS, AS WELL AS INDIVIDUALS FROM VARIOUS DEPARTMENTS OF HOSPITAL OPERATIONS AND THE HEALTH CARE SYSTEM'S HOSPITAL FOUNDATIONS. EACH HOSPITAL, WITH THE ASSISTANCE OF THE COMMUNITY BENEFIT COMMITTEE, WILL IDENTIFY ORGANIZATIONS AND RESOURCES WITHIN ITS COMMUNITY TO CONTRIBUTE TO THE HOSPITAL'S COMMUNITY NEEDS ASSESSMENT. THESE ORGANIZATIONS AND RESOURCES INCLUDE LOCAL HEALTH DEPARTMENTS, UNITED WAY, UNIVERSITIES, PUBLIC HEALTH DEPARTMENTS, ETC. THE EXISTING COMMUNITY HEALTH ASSESSMENTS PREPARED BY OTHER ORGANIZATIONS IN THE COMMUNITY WILL BE COMBINED WITH INTERNAL HOSPITAL DATA AND INFORMATION COLLECTED FROM LOCAL AGENCIES TO BECOME THE HOSPITAL'S COMMUNITY NEEDS ASSESSMENT. EACH HOSPITAL HAS ALSO TRADITIONALLY RESPONDED TO REQUESTS FOR CERTAIN COMMUNITY BENEFIT ACTIVITIES OR PROGRAMS FROM PUBLIC AGENCIES OR COMMUNITY GROUPS AND THIS WILL ALSO BE INCLUDED IN THE HOSPITAL'S COMMUNITY NEEDS ASSESSMENT. ONCE THE COMMUNITY NEEDS ASSESSMENT IS COMPLETED, WHICH WILL BE EVERY THREE YEARS, THE HOSPITAL WILL PRIORITIZE THE NEEDS BY DETERMINING WHAT HOSPITAL RESOURCES ARE AVAILABLE TO MEET THE NEEDS AND WHAT OTHER COMMUNITY RESOURCES ARE BEING USED TO MEET A PARTICULAR NEED. THE HOSPITAL WILL DEVELOP A COMMUNITY BENEFIT PLAN, WHICH WILL BE REVIEWED AND UPDATED AS NECESSARY, AT LEAST EVERY THREE YEARS. ALL HOSPITALS' COMMUNITY NEEDS ASSESSMENTS WILL BE MADE AVAILABLE TO THE PUBLIC. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEAS A NOT-FOR-PROFIT ORGANIZATION, NOVANT HEALTH IS COMMITTED TO PROVIDING OUTSTANDING HEALTH CARE TO ALL MEMBERS OF OUR COMMUNITIES, REGARDLESS OF THEIR ABILITY TO PAY. OUR ACUTE CARE FACILITIES PROVIDE CARE IN 35 COUNTIES ACROSS THREE STATES. ADDITIONALLY, OUR PHYSICIANS AND ACUTE CARE FACILITIES OFFER CARE TO NATIONAL AND INTERNATIONAL MISSION PATIENTS. OUR FINANCIAL COUNSELING TEAMS ARE CONSTANTLY WORKING WITH THE PATIENTS WITHIN OUR COMMUNITIES TO UNDERSTAND THEIR NEEDS AND ENSURE THAT OUR POLICIES AND PROCESSES ADDRESS THESE NEEDS. WE ALSO MAINTAIN CONTRACTS WITH MEDICAID ELIGIBILITY VENDORS AND LOCAL DEPARTMENT OF SOCIAL SERVICES TEAMS TO HAVE EMBEDDED CASE WORKERS WITHIN OUR FACILITIES. THESE TEAMS OFFER ADDITIONAL SUPPORT IN PROCESSING AND ASSESSING HOW WE SERVE THE FINANCIAL NEEDS OF OUR PATIENTS. BASED ON THE ASSESSMENTS OF OUR COMMUNITIES, NOVANT HEALTH HAS DEVELOPED FINANCIAL ASSISTANCE POLICIES AND PROGRAMS THAT ADDRESS THE FINANCIAL NEEDS OR OUR PATIENTS. * UNINSURED PATIENTS WITH INCOMES OF UP TO 300% OF THE FEDERAL POVERTY LEVEL ARE ELIGIBLE FOR 100% WRITE-OFF. * UNINSURED PATIENTS WITH INCOME OVER 300% OF THE FEDERAL POVERTY LEVEL ARE ELIGIBLE FOR SELF-PAY DISCOUNTS BASED ON THE PATIENT'S ANNUAL INCOME AND OUTSTANDING MEDICAL BILLS / COSTS. * ANY PATIENT (EVEN WITH HEALTH INSURANCE) WITH A BALANCE OVER $5,000 AND / OR INCOME OVER 300% OF THE FEDERAL POVERTY LEVEL IS ELIGIBLE FOR A CATASTROPHIC DISCOUNT. OUR CATASTROPHIC DISCOUNTS ARE ALSO BASED ON THE PATIENT'S ANNUAL INCOME AND OUTSTANDING MEDICAL BILLS / COSTS.* ANY PATIENT IS ELIGIBLE FOR AN INDIVIDUALIZED PAYMENT PLAN BASED ON THE AMOUNT DUE AND THE PATIENT'S FINANCIAL STATUS, WITH TERMS EXTENDING UP TO FIVE YEARS. NO INTEREST IS CHARGED, UNLESS APPROPRIATE. WE PRIDE OURSELVES IN THE TRANSPARENCY OF OUR PROGRAMS AND THE EDUCATION WE OFFER OUR PATIENTS AROUND OUR FINANCIAL ASSISTANCE POLICIES. OUR PROGRAMS ARE DOCUMENTED ON OUR CORPORATE WEBSITE AS WELL AS EACH INDIVIDUAL FACILITY'S WEBSITE, ALONG WITH CONTACT INFORMATION FOR OUR FINANCIAL COUNSELORS. ADDITIONALLY, OUR PROGRAMS ARE DOCUMENTED ON PATIENT FLYERS THROUGHOUT THE NOVANT AFFILIATED FACILITIES AND PHYSICIAN OFFICES. OUR PATIENT ACCESS SPECIALISTS, FINANCIAL COUNSELORS AND BUSINESS OFFICE TEAMS WORK WITH ALL SELF-PAY PATIENTS AND INSURED PATIENTS WITH HIGH DEDUCTIBLES TO EDUCATE THEM ON THE VARIOUS OPTIONS AVAILABLE VIA OUR FINANCIAL ASSISTANCE PROGRAMS OR GOVERNMENT SPONSORED CARE. FINALLY, WE WORK WITH LOCAL AREA FREE HEALTH CLINICS AND OTHER CHARITABLE ORGANIZATIONS TO PROVIDE CONTINUATION OF CARE FOR THEIR PATIENTS. IN ADDITION TO OUR FINANCIAL COUNSELING PROCESSES USED TO IDENTIFY CHARITY CARE PATIENTS, OUR COLLECTIONS PROCESSES WITHIN OUR BUSINESS OFFICES ALSO HELP IDENTIFY PATIENTS WHO ARE ALREADY ELIGIBLE FOR CHARITY OR WHO MAY BE ELIGIBLE BASED THEIR STATUS WITHIN THE FEDERAL POVERTY GUIDELINES ("FPG"). WE UTILIZE PREVIOUSLY SUBMITTED PATIENT DOCUMENTATION AND CREDIT AGENCY REPORTED FPG FOR DETERMINATION. SUPPORTING DOCUMENTS ARE VALID 6 MONTHS FROM THE DATE OF SUBMISSION. OUR POLICIES ARE CONSIDERED FLUID AND ARE UPDATED FREQUENTLY BASED ON LOCAL AND NATIONAL MARKET STANDARDS AND NATIONAL ECONOMIC CONDITIONS. ANY UPDATES TO OUR POLICIES REQUIRE MULTI-LEVEL LEADERSHIP APPROVAL AND ARE ULTIMATELY APPROVED BY THE NOVANT EXECUTIVE TEAM. PART VI, LINE 4: COMMUNITY INFORMATIONTHE PRESBYTERIAN HOSPITAL, INC. FORM 990 INCLUDES THE OPERATIONS OF TWO HOSPITALS. PRESBYTERIAN HOSPITAL THE ORGANIZATION DEFINES ITS COMMUNITY BY ITS PRIMARY SERVICE AREA, WHICH IS MECKLENBURG COUNTY, NORTH CAROLINA. MECKLENBURG COUNTY IS 96% URBAN AND 4% RURAL. THERE ARE FOUR NONPROFIT HOSPITALS IN THE COMMUNITY, ONE OF WHICH IS THE ORGANIZATION AND ALL OF WHICH ARE PART OF THE NOVANT HEALTH CARE SYSTEM. THERE ARE ALSO FOUR GOVERNMENTAL HOSPITALS, WHICH ARE ALL PART OF THE SAME HEALTH CARE SYSTEM. THE SPECIFIC POPULATION GROUPS (ETHNIC AND CULTURAL) FOR 2010 ARE AS FOLLOWS: WHITE NON-HISPANIC (505,553) 54%; BLACK NON-HISPANIC (271,036) 29%; HISPANIC (105,268) 11%; OTHERS (57,967) 6%; FOR A TOTAL POPULATION OF 939,824. A LITTLE OVER 13% OF THE POPULATION IS NON-ENGLISH SPEAKING. FOR 2010, THE AVERAGE HOUSEHOLD INCOME LEVEL WAS $82,682. BASED ON 2009 CENSUS DATA, APPROXIMATELY 14.2% PERCENT OF RESIDENTS ARE LIVING BELOW THE FEDERAL POVERTY LEVEL. BASED ON 2008-2009 DATA, APPROXIMATELY 20.1% OF RESIDENTS AGE 64 AND YOUNGER ARE UNINSURED. THE AGE BREAK DOWN FOR 2010 IS AS FOLLOWS: <18 YEARS (251,322) 26.7%; 18 - 44 YEARS (363,340) 38.7%; 45 - 64 YEARS (241,928) 25.7%; 65 + YEARS (83,234) 8.9%; FOR A TOTAL POPULATION OF 939,824. PRESBYTERIAN HOSPITAL HUNTERSVILLETHE ORGANIZATION DEFINES ITS COMMUNITY BY ITS PRIMARY SERVICE AREA, WHICH IS COMPRISED OF THE FOLLOWING FOUR ZIP CODES: 28031 (CORNELIUS, NORTH CAROLINA); 28078 (HUNTERSVILLE, NORTH CAROLINA); 28216 (CHARLOTTE, NORTH CAROLINA) AND 28269 (CHARLOTTE, NORTH CAROLINA). THE SERVICE AREA IS 91% URBAN AND 9% RURAL. THERE IS ONE NONPROFIT HOSPITAL IN THE COMMUNITY, WHICH IS THE ORGANIZATION. THERE IS ALSO ONE GOVERNMENTAL HOSPITAL AND ONE FOR PROFIT HOSPITAL. THE SPECIFIC POPULATION GROUPS (ETHNIC AND CULTURAL) FOR 2010 ARE AS FOLLOWS: WHITE NON-HISPANIC (115,232) 60.9%; BLACK NON-HISPANIC (50,970) 26.9%; HISPANIC (13,094) 6.9%; OTHERS (10,031) 5.3%; FOR A TOTAL POPULATION OF 189,327. FOR 2010, THE AVERAGE HOUSEHOLD INCOME LEVEL WAS $90,108. APPROXIMATELY 6% PERCENT OF RESIDENTS ARE LIVING IN POVERTY (2009). BASED ON 2010 ESTIMATES, APPROXIMATELY 11.2% OF RESIDENTS AGE 64 AND YOUNGER ARE UNINSURED. THE AGE BREAK DOWN FOR 2010 IS AS FOLLOWS: <18 YEARS (54,129) 29%; 18 - 44 YEARS (71,232) 38%; 45 - 64 YEARS (48,830) 26%; 65 + YEARS (15,136) 8%; FOR A TOTAL POPULATION OF 189,327. PART VI, LINE 6: PROMOTION OF COMMUNITY HEALTHTHE ORGANIZATION FURTHERS ITS EXEMPT PURPOSES BY DOING THE FOLLOWING:1.ADOPTING A CHARITY CARE POLICY, WHICH PROVIDES FREE CARE TO INDIVIDUALSWHOSE INCOME IS AT OR BELOW 300% OF THE FEDERAL POVERTY LEVEL;2.REMAINING CERTIFIED BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESTO PROVIDE SERVICES TO ALL BENEFICIARIES OF MEDICARE, MEDICAID, AND OTHERGOVERNMENT PAYMENT PROGRAMS, AND PROVIDING SERVICES IN A NONDISCRIMINATORYMANNER TO SUCH BENEFICIARIES;3.OPERATING A FULL-TIME EMERGENCY ROOM WHICH IS OPEN TO AND ACCEPTS ALLPERSONS, REGARDLESS OF THEIR ABILITY TO PAY;4.MAINTAINING AN OPEN MEDICAL STAFF, SUBJECT TO EXCLUSIVE CONTRACTS FOR HOSPITAL-BASED SERVICES SUCH AS ANESTHESIOLOGY, RADIOLOGY, PATHOLOGY, HOSPITALIST, AND EMERGENCY DEPARTMENT SERVICES, TO THE EXTENT AN EXCLUSIVECONTRACT FOR THOSE SERVICES IS REQUIRED TO OBTAIN PROPER STAFFING COVERAGEOR TO PERMIT A MORE EFFICIENT DELIVERY OF THOSE SERVICES WITHIN THE HOSPITAL FACILITY;5.MAINTAINING A GOVERNING BOARD CONSISTING PRIMARILY OF A BROAD CROSS-SECTION OF LEADERS IN THE COMMUNITY;6.ADOPTING AND APPLYING A CONFLICT OF INTEREST POLICY, WHICH APPLIES TO THE GOVERNING BOARD AND ORGANIZATION OFFICERS;7.PROVIDING HEALTH EDUCATION LECTURES AND WORKSHOPS.8.PROVIDING HEALTH FAIRS, EDUCATION ON SPECIFIC DISEASES OR CONDITIONS, AND HEALTH PROMOTION AND WELLNESS PROGRAMS TO THE COMMUNITIES IT SERVES;9.PROVIDING SUPPORT GROUPS AND SELF HELP PROGRAMS TO THE COMMUNITIES ITSERVES;10.PROVIDING COMMUNITY-BASED CLINICAL SERVICES, INCLUDING WITHOUT LIMITATION, HEALTH SCREENINGS AND CLINICS FOR UNINSURED OR UNDERINSURED PERSONS TO THE COMMUNITIES IT SERVES;11.PROVIDING HEALTH CARE SUPPORT SERVICES, INCLUDING WITHOUT LIMITATION,INFORMATION AND REFERRAL TO COMMUNITY SERVICES, CASE MANAGEMENT OF UNDERINSURED AND UNINSURED PERSONS, TELEPHONE INFORMATION SERVICES ANDASSISTANCE TO ENROLL IN PUBLIC PROGRAMS, SUCH AS SCHIP AND MEDICAID TO THE COMMUNITIES IT SERVES;12.PROVIDING SUBSIDIZED HEALTH SERVICES AND CLINICAL PROGRAMS TO THE COMMUNITIES IT SERVES;13.PROVIDING CASH AND IN-KIND CONTRIBUTIONS TO NONPROFIT COMMUNITY HEALTHCARE ORGANIZATIONS IN THE COMMUNITIES IT SERVES; AND14.GENERALLY PROMOTING THE HEALTH, WELLNESS, AND WELFARE OF THE COMMUNITIES IT SERVES BY PROVIDING QUALITY HEALTHCARE SERVICES AT REASONABLE COST.FOR SPECIFIC EXAMPLES OF THIS ORGANIZATION'S COMMUNITY BENEFIT ACTIVITIES, WHICH FURTHER THE ORGANIZATION'S EXEMPT PURPOSES (AND THOSE OF ALL HOSPITALS AND HEALTH CARE FACILITIES IN THE SAME HEALTH CARE SYSTEM),PLEASE SEE THE NOVANT HEALTH 2010 COMMUNITY BENEFIT REPORT, LOCATED AT HTTP://WWW.NOVANTHEALTH.ORG/DOWNLOADS/FINANCIAL_INFO/2010_COMMUNITY_INVOLVEMENT.PDF PLEASE NOTE THAT THE NUMERIC INFORMATION IN THIS REPORT IS NOT BASED UPON THE FORM 990, SCHEDULE H CRITERIA, BUT RATHER IT HAS BEEN PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HOSPITAL ASSOCIATION REPORTING GUIDELINES. PART VI, LINE 7: AFFILIATED HEALTH CARE SYSTEMTHE ORGANIZATION IS ONE OF TEN TAX-EXEMPT HOSPITALS IN THE NOVANT HEALTH CARE SYSTEM IN NORTH CAROLINA AND VIRGINIA. EACH HOSPITAL PROVIDES SUBSTANTIAL COMMUNITY BENEFIT TO THE COMMUNITY IT SERVES, AS REPORTED INDIVIDUALLY ON EACH HOSPITAL'S FORM 990, SCHEDULE H. THE COMMUNITY BENEFIT OF THE HEALTH CARE SYSTEM AS A WHOLE IS DOCUMENTED IN A SYSTEM-WIDE COMMUNITY BENEFIT REPORT, LOCATED AT HTTP://WWW.NOVANTHEALTH.ORG/DOWNLOADS/FINANCIAL_INFO/2010_COMMUNITY_INVOLVEMENT.PDF. PLEASE NOTE THAT THE NUMERIC INFORMATION IN THIS REPORT IS NOT BASED UPON THE FORM 990, SCHEDULE H CRITERIA, BUT RATHER IT HAS BEEN PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HOSPITAL ASSOCIATION REPORTING GUIDELINES. THE NOVANT HEALTH CARE SYSTEM ALSO INCLUDES AN ORGANIZATION THAT OWNS PHYSICIAN PRACTICES IN VIRGINIA, SOUTH CAROLINA, AND NORTH CAROLINA, WHICH PROVIDE ADDITIONAL COMMUNITY BENEFIT TO THEIR COMMUNITIES, AND FIVE HOSPITAL FOUNDATIONS, WHICH SUPPORT AND ENHANCE THE COMMUNITY BENEFIT ACTIVITIES IN THOSE HOSPITAL'S COMMUNITIES. FURTHER, THE NOVANT HEALTH CARE SYSTEM INCLUDES AMBULATORY SURGERY CENTERS, SKILLED NURSING FACILITIES, REHABILITATION PROGRAMS, AND OTHER OUTPATIENT FACILITIES, WHICH ALSO PROVIDE COMMUNITY BENEFIT TO THEIR COMMUNITIES. THERE ARE SIGNIFICANT COMMUNITY BENEFIT ACTIVITIES WITHIN THE NOVANT HEALTH SYSTEM, WHICH MAY NOT BE REPORTABLE ON A SCHEDULE H BECAUSE THEY ARE NOT CONDUCTED BY AN ENTITY WHICH OWNS OR OPERATES A HOSPITAL. THE HEALTH CARE SYSTEM HAS A COMMUNITY BENEFIT COMMITTEE, WHICH WILL OVERSEE AND ASSIST ALL TAX-EXEMPT HOSPITALS WITHIN NOVANT IN PREPARING THEIR COMMUNITY NEEDS ASSESSMENTS AND COMMUNITY BENEFIT PLANS. THE GOAL OF HAVING A SYSTEM-WIDE COMMITTEE IS TO IDENTIFY COMMUNITY BENEFIT ACTIVITIES THAT ARE DUPLICATIVE IN COMMUNITIES AND TO STREAMLINE AND COORDINATE EFFORTS TO RESULT IN BETTER AND MORE EFFICIENT USES OF RESOURCES, WHICH COULD LEAD TO ADDITIONAL RESOURCES TO BE ALLOCATED TO MEET OTHER COMMUNITY NEEDS, AND TO REPLICATE SUCCESSFUL PROGRAMS AND ACTIVITIES IN COMMUNITIES WHERE A SIMILAR NEED IS INDICATED. ALL OF THE TAX-EXEMPT HOSPITALS WITHIN THE NOVANT HEALTH CARE SYSTEM ARE COMMITTED TO IMPROVING THE HEALTH OF THEIR COMMUNITIES AND PROVIDING COMMUNITY BENEFIT ACTIVITIES TO SUPPORT THEIR MISSION. PART VI, LINE 7, STATE FILING OF COMMUNITY BENEFIT REPORT NCNOVANT HEALTH, INC. FILES A SYSTEM-WIDE COMMUNITY BENEFIT REPORT PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HOSPITAL ASSOCIATION REPORTING GUIDELINES WITH THE NORTH CAROLINA MEDICAL CARE COMMISSION AS PART OF THE DOCUMENTATION REQUIRED FOR THE ISSUANCE OF TAX EXEMPT BOND FINANCING. 0 AMERICAN CANCER SOCIETY 6000 FAIRVIEW RD STE 200 CHARLOTTE NC 28210 580659875 3 12000 CANCER AWARENESS AMERICAN HEART ASSOCIATION 222 SOUTH CHURCH ST STE 303 CHARLOTTE NC 28202 135613797 3 80000 COMMUNITY OUTREACH BRAIN TUMOR FOR THE CAROLINAS PO BOX 5627 CHARLOTTE NC 28299 208208247 3 60417 COMMUNITY OUTREACH CAROLINA PARENTING INC 2125 SOUTHEND DRIVE SUITE 253 CHARLOTTE NC 28203 561722858 3 7000 COMMUNITY OUTREACH CHARLOTTE AHEC PO BOX 32861 CHARLOTTE NC 28232 561398929 3 10000 COMMUNITY OUTREACH CHARLOTTE CHAMBER OF COMMERCE PO BOX 32785 CHARLOTTE NC 28232 560173610 6 40500 COMMUNITY OUTREACH CHARLOTTE MECKLENBURG BLACK HERITAGE COMMITTEE PO BOX 44025 CHARLOTTE NC 28215 113724143 3 6500 COMMUNITY OUTREACH CHARLOTTE STEEPLECHASE ASSOC POST OFFICE BOX 70 MINERAL SPRINGS NC 28108 561913942 3 7500 COMMUNITY OUTREACH CHARLOTTE TOUCHDOWN CLUB 7725 BALLANTYNE COMMONS PKWY SUITE 103 CHARLOTTE NC 28277 561854461 3 10000 COMMUNITY OUTREACH CHILDRENS THEATRE OF CHARLOTTE 300 EAST 7TH ST CHARLOTTE NC 28202 561028031 3 7500 CHILDRENS EDUCATION COLON CANCER COALITION 8009 34TH AVENUE STE 360 BLOOMINGTON MN 55425 300377727 3 10000 CANCER AWARENESS COMMUNITY BUILDING INITIATIVE 217 SOUTH TRYON STREET CHARLOTTE NC 28202 202892726 3 10000 CONSTRUCTION CAROLINAS ASSOC FOR COMM HEALTH PO BOX 31573 CHARLOTTE NC 28231 135613797 3 75000 PHYSICIAN OUTREACH DANIEL STOWE BOTANICAL GARDEN 6500 SOUTH NEW HOPE RD BELMONT NC 28012 561676433 3 10000 COMMUNITY OUTREACH ELIZABETH COMMUNITY ASSOC INC 1921 EAST 9TH STREET CHARLOTTE NC 28204 581406163 3 5500 COMMUNITY OUTREACH DISCOVERY KIDS PO BOX 237 HUNTERSVILLE NC 28078 560529944 3 84333 COMMUNITY OUTREACH GANTT CENTER 551 SOUTH TRYON STREET CHARLOTTE NC 28202 561152286 3 51500 COMMUNITY OUTREACH GIRLS ON THE RUN INTL 120 COTTAGE PL CHARLOTTE NC 28207 562201835 3 15000 COMMUNITY OUTREACH HEARTBRIGHT FOUNDATION 2923 SOUTH TRYON SUITE 200 CHARLOTTE NC 28203 450496759 3 10000 COMMUNITY OUTREACH LAKE NORMAN FREE CLINIC 14230 HUNTERS ROAD HUNTERSVILLE NC 28078 043723062 3 55000 COMMUNITY HEALTH LAKE NORMAN REGIONAL ECONOMIC DEVELOPMENT CORP 13801 REESE BLVD W STE 200-A HUNTERSVILLE NC 28078 510463069 3 12000 COMMUNITY OUTREACH LEADERSHIP CHARLOTTE PO BOX 11757 CHARLOTTE NC 28220 561684782 3 5850 COMMUNITY OUTREACH LEUKEMIA & LYMPHOMA SOCIETY 1577 NEW GARDEN RD STE D GREENSBORO NC 27410 135644916 3 13500 CANCER AWARENESS LUNG STRONG 15K 5K 3915 AUTUMN HARVEST LANE CHARLOTTE NC 28269 263677470 3 10000 COMMUNITY HEALTH MAKE A WISH FOUNDATION 212 SOUTH TRYON ST 1080 CHARLOTTE NC 28271 561492432 3 12000 COMMUNITY OUTREACH MARCH OF DIMES 410 BROOKSTOWN AVE WINSTONSALEM NC 27101 131846366 3 10000 COMMUNITY OUTREACH MECKLENBURG AQUATIC CLUB 9850 PROVIDENCE RD CHARLOTTE NC 28277 591769720 3 30000 COMMUNITY OUTREACH MEDASSIST OF MECKLENBURG 601 E 5TH STREET 350 CHARLOTTE NC 28202 562018957 3 30000 COMMUNITY HEALTH MINT HILL CHAMBER OF COMMERCE PO BOX 23223 MINT HILL NC 28227 208311079 6 8500 SCHOLARSHIP FUND NC PHYSICIANS HEALTH PROGRAM 220 HORIZON DRIVE SUITE 201 RALEIGH NC 27615 561846599 3 12000 PHYSICIAN OUTREACH PRESBYTERIAN HOSPITAL FDN 2085 FRONTIS PLAZA BLVD WINSTONSALEM NC 27103 581413074 3 100000 COMMUNITY HEALTH NC PUBLIC HEALTH FOUNDATION - COMP CANCER FUND 1922 MAIL SERVICE CENTER RALEIGH NC 27699 470921425 3 10000 CANCER AWARENESS RONALD MCDONALD HOUSE 419 S HAWTHORNE ROAD WINSTONSALEM NC 27103 581454715 3 7500 COMMUNITY OUTREACH ROTARY CLUB OF LAKE NORMAN PO BOX 2306 HUNTERSVILLE NC 28070 262902286 4 12000 COMMUNITY OUTREACH SUSAN G KOMEN FOUNDATION 5005 LBJ FREEWAY STE 250 DALLAS TX 75244 751835298 3 20000 COMMUNITY OUTREACH TOWN OF MATTHEWS 100 MCDOWELL STREET MATTHEWS NC 28105 566001283 GOVERNMENTAL 7000 COMMUNITY OUTREACH ZONYA HEALTH INTERNATIONAL 4261 COLLINS WAY LAKE OSWEGO OR 97035 383509955 3 10745 COMMUNITY OUTREACH 34 3 EDUCATIONAL SCHOLARSHIPS 10 30000 OTHER INFORMATION: PART IV: PART I, LINE 2 - PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS THE ORGANIZATION HAS GUIDELINES IN PLACE THAT ARE TO BE USED IN REVIEWING THE ELIGIBILITY AND SELECTION OF GRANTEES, BUT DOES NOT HAVE A STANDARDIZED PROCESS SYSTEM-WIDE. RECORDS ARE MAINTAINED OF THE AMOUNTS VIA THE GENERAL LEDGER. THE ORGANIZATION IS CURRENTLY WORKING TO INSTITUTE A MORE FORMAL POLICY TO ADDRESS GRANTEE ELIGIBILITY, SELECTION, AND RECORD MAINTENANCE. X X X X X X 1 1 X X X X 1 1 0 0 0 0 0 0 0 ARMATOCARL STEVEN 0 628190 0 538605 0 71788 0 1404112 0 29536 0 2672231 0 538605 BILLINGSDERRICK MARK 471153 0 216300 0 20675 0 298240 0 9525 0 1015893 0 216300 0 STILLERMANSHELLI STOKER 0 182605 0 25956 0 7950 0 38600 0 19510 0 274621 0 25956 WALSHBETSY JEAN 0 219206 0 35855 0 6153 0 61990 0 24425 0 347629 0 35855 BLACKMONTANYA S 177139 0 30600 0 6423 0 70225 0 17831 0 302218 0 30600 0 VANCEAMY SUSAN 273190 0 138054 0 12027 0 193825 0 28157 0 645253 0 138054 0 VINCENTPAULA ROLLINS 289872 0 142907 0 44360 0 219804 0 13206 0 710149 0 142907 0 ZWENGTHOMAS NELSON 377286 0 233980 0 18036 0 277359 0 30299 0 936960 0 233980 0 CAMPBELLPATRICIA T 174208 0 24428 0 21308 0 59334 0 25523 0 304801 0 0 0 DAVISTIMOTHY B 163411 0 58598 0 355 0 16879 0 7750 0 246993 0 0 0 ELMORELARRY C 134067 0 39285 0 45945 0 10966 0 15677 0 245940 0 0 0 REILINGRICHARD B 283419 0 43841 0 9363 0 83241 0 21137 0 441001 0 43841 0 SHOAF JREDWIN H 198964 0 22044 0 4060 0 44570 0 14385 0 284023 0 0 0 BOGGSLYNN I 0 0 0 0 128173 0 0 0 235 0 128408 0 0 0 PART I, LINE 1A FRINGE OR EXPENSE EXPLANATION FIRST-CLASS OR CHARTER TRAVEL: FIRST-CLASS OR CHARTER TRAVEL IS NOT A COVERED TRAVEL EXPENSE FOR EXECUTIVES; THEY ARE LIMITED TO BUSINESS OR COACH CLASS FARES FOR COMMERCIAL FLIGHTS. HOWEVER, CHARTER TRAVEL IS AVAILABLE TO CERTAIN EXECUTIVES, BOARD MEMBERS, AND APPROVED BUSINESS PERSONNEL IN LIMITED CIRCUMSTANCES DEEMED TO INVOLVE BUSINESS NECESSITY. TRAVEL FOR COMPANIONS: COMPANIONS ARE ALLOWED ON CERTAIN CHARTER FLIGHTS PAID FOR BY THE ORGANIZATION. IN THAT CASE, THE VALUE OF THE COMPANION'S FLIGHT IS CALCULATED UNDER APPLICABLE TAX LAWS AND THAT AMOUNT IS INCLUDED IN THE EXECUTIVE'S TAXABLE INCOME AS PRESCRIBED BY THE APPLICABLE TAX LAWS. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS: EXECUTIVES WHO PURCHASE SPLIT DOLLAR INSURANCE THROUGH THEIR DISCRETIONARY SPENDING ACCOUNT MAY HAVE THE ADDITIONAL INCOME TAX OWED ON THE PS-58 COSTS PAID BY THE ORGANIZATION. EXECUTIVES WHO RECEIVE TAXABLE RELOCATION INCOME MAY HAVE THE ADDITIONAL INCOME TAX OWED ON THE INCOME PAID BY THE ORGANIZATION. EXECUTIVES MAY RECEIVE AS SEVERANCE BENEFITS CASH PAYMENTS IN LIEU OF PREMIUMS PAID FOR COVERAGE OF CERTAIN GROUP BENEFITS THAT ENDED WITH THE EXECUTIVE'S TERMINATION. THE ORGANIZATION MAY PAY THE ADDITIONAL TAX OWED ON ACCOUNT OF THESE PAYMENTS. DISCRETIONARY SPENDING ACCOUNT: CERTAIN EXECUTIVES RECEIVE A DISCRETIONARY SPENDING ACCOUNT. THE DOLLAR AMOUNT IN THE ACCOUNT IS PRE-APPROVED BY THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD. THE ACCOUNT CAN BE USED ONLY FOR AN APPROVED LIST OF EXPENDITURES. ALL OPTIONS OTHER THAN A DEFERRED, AT-RISK, COMPENSATION OPTION ARE CONSIDERED TAXABLE AND ARE INCLUDED IN THE EXECUTIVE'S TAXABLE INCOME AS PRESCRIBED BY THE APPLICABLE TAX LAWS. HOUSING ALLOWANCE OR RESIDENCE FOR PERSONAL USE: WE PROVIDE TEMPORARY HOUSING ALLOWANCES IN CERTAIN EXECUTIVE RECRUITMENT AND RELOCATION PACKAGES. IN THE CASE THAT SUCH EXPENSE IS NOT REIMBURSABLE UNDER THE ACCOUNTABLE PLAN RULES, THE VALUE IS CALCULATED UNDER APPLICABLE TAX LAWS AND THAT AMOUNT IS INCLUDED IN THE EXECUTIVE'S INCOME AS PRESCRIBED BY THE APPLICABLE TAX LAWS. THE ORGANIZATION PROVIDES A TEMPORARY RESIDENCE FOR LIMITED EXECUTIVE USE THAT AT TIMES MAY INCLUDE INCIDENTAL PERSONAL USE. IN THAT CASE, THE VALUE IS CALCULATED UNDER APPLICABLE TAX LAWS AND THAT AMOUNT IS INCLUDED IN THE EXECUTIVE'S TAXABLE INCOME AS PRESCRIBED BY THE APPLICABLE TAX LAWS. HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES: IN CASES WHERE CORPORATE MEMBERSHIPS ARE NOT AVAILABLE, A MEMBERSHIP MAY BE OBTAINED IN AN EXECUTIVE'S NAME WITH A "BUSINESS USE ONLY" RESTRICTION. AT THIS TIME NOVANT HAS ONE SUCH MEMBERSHIP. PART I, LINE 4 - SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS SEVERANCE NONQUALIFIED EQUITY-BASED BOGGS, LYNN 128,173 0 0 SUPPLEMENTAL INFORMATION PART III PART III - OTHER ADDITIONAL INFORMATION DESCRIPTIONS OF SUPPLEMENTAL EXECUTIVE BENEFITS INCLUDED IN PART VII AND SCHEDULE J: EXECUTIVE ANNUAL INCENTIVE PLAN: AS PART OF THE REPORTED COMPENSATION AMOUNTS, THE REPORTING ORGANIZATION PROVIDES ANNUAL INCENTIVE COMPENSATION TO OFFICERS AND KEY EMPLOYEES UNDER AN EXECUTIVE ANNUAL INCENTIVE PLAN. THE INCENTIVE PLAN IS DESIGNED TO OFFER OPPORTUNITIES FOR ADDITIONAL COMPENSATION, BUT ONLY TO THE EXTENT THAT ELIGIBLE EXECUTIVES HAVE PROVIDED EXTRAORDINARY SERVICES AND ACHIEVED EXTRAORDINARY RESULTS THAT MEET OR EXCEED PREDETERMINED GOALS IN THE AREAS OF QUALITY, PATIENT SATISFACTION, EMPLOYEE SATISFACTION AND FINANCIAL VITALITY. THESE GOALS ARE ESTABLISHED BY INDEPENDENT AND DISINTERESTED MEMBERS OF THE NOVANT HEALTH BOARD OF TRUSTEES (WHO COMPRISE THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD). THESE GOALS ARE WEIGHTED EQUALLY. THE ADDITIONAL COMPENSATION CAN RANGE ANYWHERE FROM ZERO TO A MAXIMUM PERCENTAGE OF BASE SALARY THAT DIFFERS BY THE CLASS OF EXECUTIVE; THIS MAXIMUM PERCENTAGE RANGES FROM 30% TO 70% OF BASE SALARY. IN ADDITION, THE INDEPENDENT MEMBERS OF THE BOARD OF TRUSTEES WHO OVERSEE THE INCENTIVE COMPENSATION PROGRAM APPLY TWO "CIRCUIT BREAKERS," WHICH ARE SUBSTANTIAL LEVELS OF ORGANIZATION-WIDE ACHIEVEMENT THAT MUST BE SATISFIED BEFORE ANY AWARDS ARE PAID TO ANY EXECUTIVE UNDER THE PROGRAM. THE INCENTIVE COMPENSATION AWARDS HAVE BEEN INCLUDED IN THE COMPENSATION AMOUNTS REPORTED IN PART VII AND IN COLUMN (B)(II) OF SCHEDULE J. THEY ARE REPORTED IN THE YEAR EARNED AND ARE PAID BY MARCH 15TH OF THE SUBSEQUENT YEAR. INDEPENDENT AND DISINTERESTED MEMBERS OF THE NOVANT HEALTH BOARD OF TRUSTEES (WHO COMPRISE THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD) REVIEW, APPROVE, AND OVERSEE ALL ASPECTS AND ALL ELEMENTS OF EXECUTIVE COMPENSATION AND BENEFITS, INCLUDING THE AMOUNTS AWARDED UNDER THIS ANNUAL INCENTIVE PLAN. LONG-TERM INCENTIVE PLAN: THE REPORTING ORGANIZATION OFFERS A LONG-TERM INCENTIVE PLAN (THE "PLAN") TO CERTAIN KEY EXECUTIVES. THE PLAN TIES A KEY EXECUTIVE'S COMPENSATION TO THE ORGANIZATION'S LONG-TERM STRATEGIC PERFORMANCE, PROVIDES A RETENTION INCENTIVE FOR KEY EXECUTIVES, AND ALLOWS THE ORGANIZATION TO COMPETE IN THE MARKETPLACE FOR TOP LEADERSHIP TALENT. THE PLAN OPERATES ON THREE-YEAR PERFORMANCE CYCLES THAT BEGIN EACH YEAR. LONG-TERM STRATEGIC GOALS (IN THE PRINCIPAL AREAS OF QUALITY OF PATIENT CARE AND LONG-TERM FINANCIAL STRENGTH) ARE ESTABLISHED FOR EACH CYCLE, IN ADVANCE, BY INDEPENDENT AND DISINTERESTED MEMBERS OF THE NOVANT HEALTH BOARD OF TRUSTEES (WHO COMPRISE THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD). A MINIMUM LEVEL OF COMMUNITY BENEFIT AND CHARITY CARE, AS WELL AS A MINIMUM LEVEL OF FINANCIAL PERFORMANCE, IS REQUIRED BEFORE ANY AWARD CAN BE PAID UNDER THE PLAN. NOVANT HEALTH'S INTERNAL AUDIT DEPARTMENT REVIEWS THE METHODOLOGY AND PROCESS USED TO DETERMINE ACHIEVEMENT OF THE QUALITY METRICS. AWARDS ARE PAYABLE FOR A PARTICULAR THREE-YEAR PERFORMANCE CYCLE ONLY IF THE REQUISITE LEVEL OF COMMUNITY BENEFIT AND CHARITY CARE, ALONG WITH THE REQUIRED LEVEL OF FINANCIAL PERFORMANCE TO DEMONSTRATE LONG-TERM FINANCIAL STRENGTH, HAVE BEEN MET FOR THAT RESPECTIVE THREE-YEAR PERFORMANCE PERIOD. IF AN AWARD IS EARNED AT THE END OF A PERFORMANCE CYCLE, THEN THE INCENTIVE AWARD IS PAID OUT AND IS INCLUDED IN THE COMPENSATION AMOUNTS REPORTED IN PART VII AND IN COLUMN (B)(II) OF SCHEDULE J. THE AWARD IS REPORTED IN THE YEAR EARNED AND IS PAID BY MARCH 15TH OF THE SUBSEQUENT YEAR. INDEPENDENT AND DISINTERESTED MEMBERS OF THE NOVANT HEALTH BOARD OF TRUSTEES (WHO COMPRISE THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD) REVIEW, APPROVE, AND OVERSEE ALL ASPECTS AND ALL ELEMENTS OF EXECUTIVE COMPENSATION AND BENEFITS, INCLUDING THE AMOUNTS AWARDED UNDER THIS LONG-TERM INCENTIVE PLAN. SCHEDULE J PART I LINE 4A - SEVERANCE PLAN: ELIGIBLE EXECUTIVES MAY RECEIVE SEVERANCE PAY THAT IS A SPECIFIED MULTIPLE OF ANNUAL COMPENSATION. THE SEVERANCE PAY WOULD BE PAID ONLY IN THE EVENT OF CERTAIN TYPES OF EMPLOYMENT TERMINATION, AND IS FURTHER CONTINGENT ON THE SATISFACTION OF OTHER CONDITIONS SUCH AS COMPLIANCE WITH A NON-COMPETITION COVENANT. ANY CURRENT YEAR PAYMENTS HAVE BEEN INCLUDED IN THE COMPENSATION AMOUNTS REPORTED IN PART VII AND IN COLUMN (B)(III) OF SCHEDULE J. INDEPENDENT AND DISINTERESTED MEMBERS OF THE NOVANT HEALTH BOARD OF TRUSTEES (WHO COMPRISE THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD) REVIEW, APPROVE, AND OVERSEE ALL ASPECTS AND ALL ELEMENTS OF EXECUTIVE COMPENSATION AND BENEFITS, INCLUDING THE AMOUNTS AWARDED UNDER THIS SEVERANCE PLAN. SCHEDULE J PART I LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS: SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN: THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("SERP") IS INTENDED TO SUPPORT RETENTION OF KEY EXECUTIVES, AND TO OFFER COMPETITIVE TOTAL COMPENSATION. THESE SERP BENEFITS ARE CALCULATED WITH REFERENCE TO A FORMULA THAT TAKES INTO CONSIDERATION THE EXECUTIVE'S TOTAL YEARS OF SERVICE WITH THE ORGANIZATION AND OTHER RETIREMENT INCOME. THESE BENEFITS ARE FULLY AT RISK AND WILL NOT BE PAID UNLESS THE EXECUTIVE PROVIDES SUBSTANTIAL FUTURE SERVICES TO THE ORGANIZATION. UNTIL THOSE REQUIREMENTS ARE SATISFIED, IF EVER, THE EXECUTIVE IS NOT ENTITLED TO ANY SERP BENEFIT. IF THE EXECUTIVE WERE TO HAVE LEFT THE ORGANIZATION VOLUNTARILY DURING THE YEAR FOR WHICH THESE AMOUNTS ARE BEING REPORTED (BEFORE REACHING BOTH AGE 55 AND HAVING FIVE YEARS OF SERVICE WITH THE ORGANIZATION), THE EXECUTIVE'S SERP BENEFIT WOULD HAVE BEEN ENTIRELY FORFEITED. THE SERP BENEFIT IS REDUCED AT THE RATE OF 2 PERCENTAGE POINTS PER YEAR FOR PAYMENTS RECEIVED BETWEEN THE AGES OF 55 AND 62. CURRENT YEAR PAYMENTS OF SERP BENEFITS HAVE BEEN INCLUDED IN THE COMPENSATION AMOUNTS REPORTED IN PART VII AND IN COLUMN (B)(III) OF SCHEDULE J. AN ESTIMATE OF THE ANNUAL INCREASE IN ACTUARIAL VALUE IS REPORTED AS DEFERRED COMPENSATION IN PART VII AND IN COLUMN (C) OF SCHEDULE J FOR ELIGIBLE EXECUTIVES. INDEPENDENT AND DISINTERESTED MEMBERS OF THE NOVANT HEALTH BOARD OF TRUSTEES (WHO COMPRISE THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD) REVIEW, APPROVE, AND OVERSEE ALL ASPECTS AND ALL ELEMENTS OF EXECUTIVE COMPENSATION AND BENEFITS, INCLUDING THE AMOUNTS AWARDED UNDER THIS SUPPLEMENTAL RETIREMENT PLAN. ACTIVITIES FORM 990, PART I, LINE 1: ORGANIZATION'S MISSION OR MOST SIGNIFICANT PRESBYTERIAN HOSPITAL AND PRESBYTERIAN HOSPITAL HUNTERSVILLE ARE INTEGRAL PARTS OF THE NOVANT HEALTH SYSTEM (COLLECTIVELY KNOWN AS "NOVANT"), A NOT-FOR-PROFIT INTEGRATED GROUP OF HOSPITALS, PHYSICIAN CLINICS, OUTPATIENT CENTERS AND OTHER HEALTHCARE SERVICES - RANKED AS ONE OF OUR NATION'S TOP 20 HEALTHCARE SYSTEMS - CARING FOR PATIENTS AND COMMUNITIES IN NORTH CAROLINA, VIRGINIA AND SOUTH CAROLINA. THE NOVANT HEALTH SYSTEM REPORTED $3.392 BILLION IN REVENUES IN 2010. PRESBYTERIAN HOSPITAL AND PRESBYTERIAN HOSPITAL HUNTERSVILLE EXIST TO IMPROVE THE HEALTH OF THE COMMUNITIES THEY SERVE WITH A VISION OF PROVIDING A REMARKABLE PATIENT EXPERIENCE IN EVERY DIMENSION, EVERY TIME. THEY ACCOMPLISH THAT MISSION BY PROVIDING HEALTHCARE SERVICES TO ALL WHO ENTRUST THEIR CARE TO THEM AND BY SUPPORTING THE GREATER CHARLOTTE COMMUNITY THROUGH PARTNERSHIPS AND OUTREACH. THE HOSPITALS SUPPORT ORGANIZATIONS THAT PROVIDE HEALTH SERVICES, EDUCATION AND ASSISTANCE TO THE UNINSURED AND OVERALL COMMUNITY. IN ADDITION TO OUR QUALITY OF SERVICES, WE'RE VERY PROUD OF OUR PATIENT FINANCIAL ASSISTANCE PROGRAM. WE WORK WITH INDIVIDUALS TO HELP QUALIFY THEM FOR PUBLIC ASSISTANCE, ESTABLISH A REASONABLE PAYMENT PLAN, DISCOUNT THEIR BILL TO REFLECT THEIR PERSONAL RESOURCES OR PROVIDE THEM WITH FREE CHARITY CARE. COMMUNITY OUTREACH THE HOSPITALS ARE PROUD OF THEIR OUTREACH EFFORTS, SUCH AS THE PRESBYTERIAN HOSPITAL COMMUNITY CARE CRUISER, SUPPORTED ENTIRELY BY DONATIONS SECURED THROUGH THE PRESBYTERIAN HOSPITAL FOUNDATION. THE CRUISER IS A 38-FOOT MEDICAL CLINIC-ON-WHEELS. THE CLINICAL STAFF ON THE CRUISER PROVIDES PRIMARY AND PREVENTIVE PEDIATRIC MEDICAL CARE TO UNDERSERVED CHILDREN IN CHARLOTTE AND SURROUNDING AREAS. THE CRUISER HAS JOURNEYED INTO AT-RISK NEIGHBORHOODS, LOGGED MORE THAN 15,000 MILES, TREATED MORE THAN 5,500 PATIENTS, ADMINISTERED MORE THAN 7,600 IMMUNIZATIONS AND PROVIDED REFERRALS TO MORE THAN 35 COMMUNITY RESOURCES SINCE ITS LAUNCH IN 2007. PRESBYTERIAN HOSPITAL HUNTERSVILLE CONTINUED ITS COMMUNITY PARTNERSHIP WITH THREE LOCAL SCHOOLS IN 2010 CALLED, "LEARN WELL. BE WELL!" THE PROGRAM PROMOTES HEALTHY LIFESTYLES THROUGH EDUCATION AND FITNESS ACTIVITIES FOR STUDENTS AND TEACHERS. NEW TECHNOLOGY & SERVICES PRESBYTERIAN HOSPITAL AND PRESBYTERIAN HOSPITAL HUNTERSVILLE ARE CONTINUALLY ANALYZING OUR HEALTHCARE OFFERING TO DETERMINE WHAT NEW TECHNOLOGY AND SERVICES SHOULD BE PROVIDED FOR OUR PATIENTS. IN 2010, PRESBYTERIAN HOSPITAL INTRODUCED THE FOLLOWING NEW SERVICES: - PRESBYTERIAN AORTIC CENTER - THIS CENTER SPECIALIZES IN THE TREATMENT OF AORTIC ANEURYSMS AND DISSECTIONS - INCLUDING MULTI-STAGED, COMPLEX CASES. OUR TEAM OF SPECIALISTS INCLUDES VASCULAR AND CARDIOTHORACIC SURGEONS, CARDIOLOGISTS AND OTHER MEDICAL PROFESSIONALS WHO DIAGNOSIS, TREAT AND PROVIDE FOLLOW-UP CARE OF AORTIC DISEASE PATIENTS. IF SURGERY IS NEEDED, IT WILL TAKE PLACE IN PRESBYTERIAN HOSPITAL'S HYBRID OPERATING ROOM - THE FIRST OF ITS KIND IN THE REGION. - MINIMALLY INVASIVE IMPLANTABLE DEFIBRILLATOR - THROUGH A GROUNDBREAKING CLINICAL TRIAL FOR SUDDEN CARDIAC DEATH PATIENTS, PRESBYTERIAN HOSPITAL CONDUCTED ITS FIRST S-ICD SYSTEM IMPLANTATION ON SEPTEMBER 9TH. THIS NEW TREATMENT PROVIDES A LESS INVASIVE, POTENTIALLY LOWER-RISK TREATMENT OPTION TO INDIVIDUALS WHO ARE AT RISK FOR SUDDEN CARDIAC DEATH. - CARDIO-ONCOLOGY PROGRAM - OUR CARDIOLOGISTS AND ONCOLOGISTS HAVE TEAMED UP TO FIGHT A GROWING PROBLEM OF CHEMOTHERAPY AND RADIATION TREATMENTS THAT DAMAGE THE HEARTS OF SOME CANCER SURVIVORS. THESE EXPERTS IDENTIFY THE RISK OF HEART DISEASE FOR CANCER SURVIVORS OR PATIENTS CURRENTLY UNDERGOING TREATMENT FOR CANCER AND THEN TAKE A LEADING-EDGE, CUSTOMIZED APPROACH TO LESSENING THE IMPACT OF HEART DISEASE ON EACH PATIENT. AWARDS, RECOGNITIONS & RE-CERTIFICATIONS PRESBYTERIAN HOSPITAL AND PRESBYTERIAN HOSPITAL HUNTERSVILLE WERE THE RECIPIENTS OF SEVERAL NATIONAL AWARDS IN 2010: - START! FIT-FRIENDLY COMPANY - PRESBYTERIAN HEALTHCARE WAS AWARDED PLATINUM-LEVEL RECOGNITION AS A START! FIT-FRIENDLY COMPANY BY THE AMERICAN HEART ASSOCIATION (AHA), ONE OF JUST FOUR ORGANIZATIONS IN THE GREATER CHARLOTTE AREA TO DO SO. PRESBYTERIAN HAS HELD GOLD-LEVEL STATUS FOR THE PAST TWO YEARS. IN ORDER TO RECEIVE START! FIT-FRIENDLY RECOGNITION, COMPANIES MUST DEMONSTRATE A COMMITMENT TO PROMOTING EXERCISE AND HEALTHY EATING HABITS IN THE WORKPLACE. - CHEST PAIN CENTER ACCREDITATION - THE SOCIETY OF CHEST PAIN CENTERS ACCREDITATION REVIEW COMMITTEE AWARDED PRESBYTERIAN HOSPITAL HUNTERSVILLE WITH CYCLE III ACCREDITATION STATUS, WHILE PRESBYTERIAN HOSPITAL WAS AWARDED CYCLE III ACCREDITATION WITH PCI, A SPECIAL DESIGNATION FOR ITS INTERVENTIONAL CATHETERIZATION PROGRAM. - CORONARY CARE UNIT TOP PERFORMER AWARD - THE CORONARY CARE UNIT (CCU) AT PRESBYTERIAN HOSPITAL WAS HONORED WITH A TOP PERFORMER AWARD BY PROFESSIONAL RESEARCH CONSULTANTS (PRC), A NATIONAL HEALTHCARE MARKETING ORGANIZATION THAT CONDUCTS SATISFACTION SURVEYS TO EVALUATE HOSPITALS. THE UNIT WAS THE ONLY TOP PERFORMER WINNER IN ITS CATEGORY AND WAS THE HIGHEST-SCORING CCU AMONG THOSE THAT WERE ELIGIBLE. - GOLD SEAL ORTHOPAEDIC DISEASE-SPECIFIC CARE CERTIFICATIONS - PRESBYTERIAN ORTHOPAEDIC HOSPITAL'S JOINT AND SPINE PROGRAMS EARNED THE GOLD SEAL OF APPROVAL FOR HEALTHCARE QUALITY. THE JOINT COMMISSION AWARDED POH DISEASE-SPECIFIC CARE CERTIFICATION FOR: HIP FRACTURE, HIP REPLACEMENT , KNEE REPLACEMENT , LAMINECTOMY AND SPINAL FUSION. TO EARN THIS DISTINCTION, DISEASE MANAGEMENT PROGRAMS MUST UNDERGO AN EXTENSIVE, UNANNOUNCED, ONSITE EVALUATION BY A TEAM OF JOINT COMMISSION REVIEWERS EVERY TWO YEARS. - STROKE CENTER RE-CERTIFICATION - AFTER A SITE REVIEW, THE JOINT COMMISSION APPROVED PRESBYTERIAN HOSPITAL AND PRESBYTERIAN HOSPITAL HUNTERSVILLE TO RETAIN THEIR PRIMARY STROKE CENTERS DESIGNATION FOR ANOTHER TWO YEARS. THE DESIGNATION IS BASED ON COMPLIANCE WITH CONSENSUS-BASED NATIONAL STANDARDS, EFFECTIVE USE OF ESTABLISHED CLINICAL PRACTICE GUIDELINES TO MANAGE AND OPTIMIZE CARE, AS WELL AS PERFORMANCE MEASUREMENT AND IMPROVEMENT ACTIVITIES. THE CERTIFICATION RECOGNIZES CENTERS THAT MAKE EXCEPTIONAL EFFORTS TO FOSTER BETTER OUTCOMES FOR STROKE CARE, THEREBY DELIVERING THE BEST CARE POSSIBLE TO THEIR PATIENTS. COMMUNITY BENEFIT REPORT: HTTP://WWW.NOVANTHEALTH.ORG/DOWNLOADS/FINANCIAL_INFO/2010_COMMUNITY_ INVOLVEMENT.PDF THE COMMUNITY BENEFIT REPORT PREPARED BY NOVANT HEALTH IS A SYSTEM-WIDE REPORT THAT INCLUDES QUALITATIVE AND QUANTITATIVE INFORMATION. IN THIS REPORT, THE NOVANT HEALTH SYSTEM'S COMMUNITY BENEFIT WAS APPROXIMATELY $469,000,000 IN 2010. PLEASE NOTE THAT THE NUMERIC DATA IN THIS REPORT IS NOT BASED UPON THE FORM 990, SCHEDULE H CRITERIA, BUT RATHER IT HAS BEEN PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HOSPITAL ASSOCIATION REPORTING GUIDELINES. IT SHOULD NOT BE RELIED UPON AS THE ORGANIZATION'S FORM 990, SCHEDULE H COMMUNITY BENEFIT REPORT. FORM 990, PART III, LINE 1: MISSION, VISION, AND VALUES MISSION: NOVANT HEALTH EXISTS TO IMPROVE THE HEALTH OF COMMUNITIES, ONE PERSON AT A TIME. VISION: WE, THE EMPLOYEES OF NOVANT AND OUR PHYSICIAN PARTNERS, WILL DELIVER THE MOST REMARKABLE PATIENT EXPERIENCE, IN EVERY DIMENSION, EVERY TIME. VALUES: COMPASSION: WE TREAT OUR CUSTOMERS AND THEIR FAMILIES, STAFF AND OTHER HEALTHCARE PROVIDERS AS FAMILY MEMBERS BY SHOWING THEM KINDNESS, PATIENCE, EMPATHY AND RESPECT. DIVERSITY: WE RECOGNIZE THAT EVERY PERSON IS DIFFERENT, EACH SHAPED BY UNIQUE LIFE EXPERIENCES. THIS ENABLES US TO BETTER UNDERSTAND ONE ANOTHER AND OUR CUSTOMERS. PERSONAL EXCELLENCE: WE STRIVE TO GROW PERSONALLY AND PROFESSIONALLY, AND WE APPROACH EACH SERVICE OPPORTUNITY WITH A POSITIVE, FLEXIBLE ATTITUDE. HONESTY AND PERSONAL INTEGRITY GUIDE ALL THAT WE DO. TEAMWORK: THE NEEDS AND EXPECTATIONS OF ANY ONE CUSTOMER ARE GREATER THAN THAT WHICH ONE PERSON'S SERVICE EFFORTS CAN SATISFY. WE SUPPORT EACH OTHER SO THAT TOGETHER AS A TEAM, WE CAN BE SUCCESSFUL IN THE EYE OF THE CUSTOMER AS A QUALITY SERVICE PROVIDER. FORM 990, PART I, LINE 6: THE NUMBER OF VOLUNTEERS REPORTED INCLUDES THOSE VOLUNTEERS SERVING AS BOARD MEMBERS. FORM 990, PART III, LINE 4A: FIRST ACHIEVEMENT PHH HAD 60 LICENSED BEDS. THERE WERE 20,369 PATIENT DAYS, WITH AN AVERAGE LENGTH OF STAY OF 3.6 DAYS AND AN AVERAGE DAILY CENSUS OF 56. THERE WERE 5,656 DISCHARGES, 5,351 INPATIENT AND OUTPATIENT SURGERIES, 56,635 OUTPATIENT ENCOUNTERS AND 33,417 EMERGENCY DEPARTMENT VISITS. FORM 990, PART VI, SECTION A, LINE 2 FAMILY AND/OR BUSINESS RELATIONSHIPS BUSINESS RELATIONSHIP ARTHUR GALLAGHER SECRETARY JAMES PALERMO VICE CHAIRMAN FORM 990, PART VI, SECTION A, LINE 6 CLASSES OF MEMBERS OR STOCKHOLDERS THE CORPORATION IS A NONPROFIT CORPORATION WITH MEMBERS (OR A MEMBER). FORM 990, PART VI, SECTION A, LINE 7A ELECTION OF MEMBERS AND THEIR RIGHTS THE BOARD MEMBERS OF THE GOVERNING BODY OF PRESBYTERIAN HOSPITAL ARE THE SAME AS THOSE OF THE NOVANT HEALTH SOUTHERN PIEDMONT REGION, LLC, A RELATED ENTITY. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS SUBJECT TO APPROVAL OF MEMBERS THE BOARD OF NOVANT HEALTH, INC. APPROVES CHANGES MADE TO THE PRESYTERIAN HOSPITAL BYLAWS. FORM 990, PART VI, SECTION B, LINE 11 ORGANIZATION'S PROCESS TO REVIEW FORM 990 THE BOARD HAS DELEGATED REVIEW OF THE FORM 990 TO NOVANT HEALTH'S AUDIT AND COMPLIANCE COMMITTEE, WHICH OVERSEES TAX MATTERS FOR NOVANT HEALTH. THE AUDIT AND COMPLIANCE COMMITTEE IS THE REVIEW BODY FOR ALL OF THE FORM 990S FILED FOR ORGANIZATIONS WITHIN THE NOVANT HEALTH SYSTEM. THE AUDIT AND COMPLIANCE COMMITTEE MEETS BEFORE THE FORM 990S ARE FILED WITH THE IRS AND AFTER ALL BOARD MEMBERS HAVE RECEIVED A COPY OF THE FORM 990 AND A SUMMARY OF ITS CONTENTS. THE DIRECTOR OF TAX AND BENEFITS AND LEGAL COUNSEL FOR NOVANT HEALTH ATTEND THE MEETING TO ANSWER ANY QUESTIONS AND ADDRESS ANY SIGNIFICANT DISCLOSURES WITHIN THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C ENFORCEMENT OF CONFLICTS POLICY THE ORGANIZATION'S TRUSTEE CONFLICT OF INTEREST POLICY APPLIES TO ALL TRUSTEES, PRINCIPAL OFFICERS OR MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS INCLUDING ANY APPLICABLE DISREGARDED ENTITIES. ALL TRUSTEES ARE SENT AN ANNUAL DISCLOSURE FORM. ANY POSITIVE ANSWERS ON THE TRUSTEE ANNUAL DISCLOSURE FORM ARE REVIEWED BY THE GENERAL COUNSEL. IF THE RELATIONSHIP DISCLOSED IS DETERMINED NOT TO POSE A POTENTIAL CONFLICT OF INTEREST GENERALLY, THEN NO ACTION IS TAKEN. WITH RESPECT TO PARTICULAR TRANSACTIONS THAT COME BEFORE THE BOARD, THE POTENTIAL CONFLICT OF INTEREST IS DISCLOSED BY THE BOARD MEMBER, GENERALLY IN ADVANCE OF THE MEETING AT WHICH A VOTE IS TO TAKE PLACE, AND LEGAL COUNSEL DISCUSSES THE POTENTIAL CONFLICT OF INTEREST WITH THE BOARD MEMBER. THE BOARD MEMBER IS INSTRUCTED IN ACCORDANCE WITH THE TRUSTEE CONFLICT OF INTEREST POLICY. IF A CONFLICT OF INTEREST IS FOUND TO EXIST, THEN THE BOARD MEMBER WITH THE CONFLICT REFRAINS FROM PARTICIPATION IN THE BOARD'S DELIBERATIONS AND VOTE ON THE TRANSACTION. FORM 990, PART VI, SECTION B, LINE 13: WRITTEN WHISTLEBLOWER POLICY THE ORGANIZATION IS PART OF THE NOVANT HEALTH, INC. ("NOVANT HEALTH") HEALTH CARE SYSTEM. NOVANT HEALTH'S BYLAWS AUTHORIZE IT TO ESTABLISH CERTAIN POLICIES FOR ALL OF ITS SUBSIDIARIES COMPRISING THE HEALTH CARE SYSTEM. ALL SUBSIDIARY ORGANIZATIONS FOLLOW ALL APPLICABLE NOVANT HEALTH CORPORATE POLICIES IN THEIR OPERATIONS. NOVANT HEALTH HAS ESTABLISHED A WHISTLEBLOWER POLICY, WHICH ALL SUBSIDIARY ORGANIZATIONS IN THE HEALTH CARE SYSTEM FOLLOW. THE INDIVIDUAL SUBSIDIARY ORGANIZATION BOARD OF TRUSTEES DO NOT SPECIFICALLY ADOPT OR APPROVE EACH OPERATING POLICY, AS THERE ARE HUNDREDS OF POLICIES THAT APPLY TO ALL SUBSIDIARY ORGANIZATIONS AND THEY CANNOT PRACTICABLY BE APPROVED BY ALL OF THE INDIVIDUAL BOARDS. FORM 990, PART VI, SECTION B, LINE 14: WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY THE ORGANIZATION IS PART OF THE NOVANT HEALTH, INC. ("NOVANT HEALTH") HEALTH CARE SYSTEM. NOVANT HEALTH'S BYLAWS AUTHORIZE IT TO ESTABLISH CERTAIN POLICIES FOR ALL OF ITS SUBSIDIARIES COMPRISING THE HEALTH CARE SYSTEM AND THE ORGANIZATION'S ARTICLES OF INCORPORATION RECOGNIZE NOVANT HEALTH'S AUTHORITY TO ESTABLISH CERTAIN POLICIES FOR THE ORGANIZATION. ALL SUBSIDIARY ORGANIZATIONS FOLLOW ALL APPLICABLE NOVANT HEALTH CORPORATE POLICIES IN THEIR OPERATIONS. NOVANT HEALTH HAS ESTABLISHED A DOCUMENT RETENTION AND DESTRUCTION POLICY, WHICH ALL SUBSIDIARY ORGANIZATIONS IN THE HEALTH CARE SYSTEM FOLLOW. THE INDIVIDUAL SUBSIDIARY ORGANIZATION BOARD OF TRUSTEES DO NOT SPECIFICALLY ADOPT OR APPROVE EACH OPERATING POLICY, AS THERE ARE HUNDREDS OF POLICIES THAT APPLY TO ALL SUBSIDIARY ORGANIZATIONS AND THEY CANNOT PRACTICABLY BE APPROVED BY ALL OF THE INDIVIDUAL BOARDS. FORM 990, PART VI, SECTION B, LINE 15 FORM 990, PART VI, SECTION B, LINE 15A: COMPENSATION PROCESS FOR TOP OFFICIAL INDEPENDENT AND DISINTERESTED MEMBERS OF THE NOVANT HEALTH BOARD OF TRUSTEES (WHO COMPRISE THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD) REVIEW, APPROVE, AND OVERSEE ALL ASPECTS OF EXECUTIVE COMPENSATION AND BENEFITS, INCLUDING FOR THOSE EXECUTIVES SERVING RELATED OR DISREGARDED ENTITIES. THE COMMITTEE WORKS WITH AN INDEPENDENT COMPENSATION CONSULTANT, USES THIRD PARTY COMPARABILITY DATA FOR FUNCTIONALLY SIMILAR POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS, AND MAKES SURE THAT TOTAL COMPENSATION AND BENEFITS FOR EACH EXECUTIVE DO NOT EXCEED FAIR MARKET VALUE WHEN COMPARED TO THE MARKET DATA FOR EXECUTIVES IN A SIMILAR POSITION. THE COMMITTEE REVIEWS AND APPROVES EXECUTIVE COMPENSATION AND BENEFITS ANNUALLY, CONSISTENT WITH THE WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY OF NOVANT HEALTH, AND IN A MANNER THAT QUALIFIES FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS, THEREBY ASSURING THAT TOTAL COMPENSATION AND BENEFITS PROVIDED TO EACH EXECUTIVE IS REASONABLE. THE COMMITTEE REVIEWS AND APPROVES EACH ITEM OF THE NOVANT HEALTH SYSTEM CEO'S COMPENSATION AND BENEFITS. FORM 990, PART VI, SECTION B, LINE 15B: COMPENSATION PROCESS FOR OFFICERS INDEPENDENT AND DISINTERESTED MEMBERS OF THE NOVANT HEALTH BOARD OF TRUSTEES (WHO COMPRISE THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD) REVIEW, APPROVE, AND OVERSEE ALL ASPECTS OF EXECUTIVE COMPENSATION AND BENEFITS, INCLUDING FOR THOSE EXECUTIVES SERVING RELATED OR DISREGARDED ENTITIES. THE COMMITTEE WORKS WITH AN INDEPENDENT COMPENSATION CONSULTANT, USES THIRD PARTY COMPARABILITY DATA FOR FUNCTIONALLY SIMILAR POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS, AND MAKES SURE THAT TOTAL COMPENSATION AND BENEFITS FOR EACH EXECUTIVE DO NOT EXCEED FAIR MARKET VALUE WHEN COMPARED TO THE MARKET DATA FOR EXECUTIVES IN A SIMILAR POSITION. THE COMMITTEE REVIEWS AND APPROVES EXECUTIVE COMPENSATION AND BENEFITS ANNUALLY, CONSISTENT WITH THE WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY OF NOVANT HEALTH, AND IN A MANNER THAT QUALIFIES FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS, THEREBY ASSURING THAT TOTAL COMPENSATION AND BENEFITS PROVIDED TO EACH EXECUTIVE IS REASONABLE. LASTLY, IT REVIEWS AND APPROVES ALL OF THE ELEMENTS AND SPECIFICATIONS INCLUDED IN ALL OTHER EXECUTIVE COMPENSATION PLANS AND PROGRAMS (E.G, INCENTIVE PLAN DESIGN, AWARD OPPORTUNITIES, ETC.). FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS DISCLOSURE THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS CONTAINING ALL ORGANIZATIONS IN THE NOVANT HEALTH SYSTEM ARE POSTED TO THE NOVANT HEALTH WEBSITE. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE TO THE PUBLIC. FORM 990, PART VII, SECTION A, COLUMN B: RELATED ORGANIZATIONS THE ORGANIZATION EMPLOYS CERTAIN EXECUTIVES WHOSE ROLES ARE SUCH THAT THEY PROVIDE SERVICES TO NOT ONLY THE ORGANIZATION, BUT ALSO TO SOME OR ALL OF THE OTHER TAX-EXEMPT ORGANIZATIONS WITHIN THE NOVANT HEALTH CARE SYSTEM. FOR EXAMPLE, MANY OF THESE EXECUTIVES' ROLES FOCUS ON PARTICULAR SERVICE LINES WHICH CROSS THE VARIOUS GEOGRAPHIC MARKETS OUR ORGANIZATIONS SERVE, THUS THE SERVICES PROVIDED BY THESE EXECUTIVES MAY BENEFIT AND BE RECEIVED BY MULTIPLE ORGANIZATIONS WITHIN THE SYSTEM. THE EXECUTIVES DO NOT ALLOCATE THEIR HOURS BETWEEN THE VARIOUS ORGANIZATIONS, BUT RATHER THEIR TIME SPENT ON SERVICES TO THE ORGANIZATION IS INCLUSIVE OF SERVICES TO ALL OF THE ORGANIZATIONS THEY SERVE WITHIN THE SYSTEM. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: AFFILIATE TRANSFERS -1,559,884. MALPRACTICE INSURANCE ADJUSTMENT -2,520,664. K-1 ADJUSTMENTS -6,865,347. TOTAL TO FORM 990, PART XI, LINE 5: -10,945,895. AUXILIARY OF FORSYTH MEMORIAL HOSPITAL 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 560862112 HEALTHCARE NC 501(C)(3) 9 FORSYTH MEMORIAL HOSPITAL 0 CAROLINA MEDICORP ENTERPRISES 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 581466368 HEALTHCARE NC 501(C)(3) 11B NOVANT MEDICAL GROUP 0 COMMUNITY GENERAL HEALTH PARTNERS 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 560636250 HEALTHCARE NC 501(C)(3) 3 NOVANT HEALTH TRIAD REGION 0 COMMUNITY GENERAL HOSPITAL FOUNDATION 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 561828629 HEALTHCARE NC 501(C)(3) 7 COMMUNITY GENERAL HEALTH PARTNERS 0 CONTINUING CARE SERVICES 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 541288473 HEALTHCARE VA 501(C)(3) 9 PRINCE WILLIAM HEALTH SYSTEM 0 FORSYTH MEDICAL CENTER FOUNDATION 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 562120959 HEALTHCARE NC 501(C)(3) 7 FORSYTH MEMORIAL HOSPITAL 0 FORSYTH MEMORIAL HOSPITAL 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 560928089 HEALTHCARE NC 501(C)(3) 3 NOVANT HEALTH TRIAD REGION 0 FOUNDATION HEALTH SYSTEMS CORP 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 561373175 HEALTHCARE NC 501(C)(3) 9 NOVANT HEALTH TRIAD REGION 0 MEDICAL PARK HOSPITAL 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 561340424 HEALTHCARE NC 501(C)(3) 3 NOVANT HEALTH TRIAD REGION 0 NOVANT HEALTH INC 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 561376950 HEALTHCARE NC 501(C)(3) 11C N/A 0 NOVANT MEDICAL GROUP 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 581728803 HEALTHCARE NC 501(C)(3) 3 NMG SERVICES INC 0 PERSONAL CARE SERVICES 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 541291284 HEALTHCARE VA 501(C)(3) 9 PRINCE WILLIAM HEALTH SYSTEM 0 PRESBYTERIAN HOSPITAL FOUNDATION 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 581413074 HEALTHCARE NC 501(C)(3) 7 NOVANT HEALTH SOUTHERN PIEDMONT REGION 0 PRESBYTERIAN MEDICAL CARE CORPORATION 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 561376368 HEALTHCARE NC 501(C)(3) 3 NOVANT HEALTH SOUTHERN PIEDMONT REGION 0 PRINCE WILLIAM HEALTH SYSTEM 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 541278944 HEALTHCARE VA 501(C)(3) 11C NOVANT HEALTH 0 PRINCE WILLIAM HEALTH SYSTEM FOUNDATION 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 541307595 HEALTHCARE VA 501(C)(3) 11A PRINCE WILLIAM HEALTH SYSTEM 0 PRINCE WILLIAM HOSPITAL 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 540696355 HEALTHCARE VA 501(C)(3) 3 PRINCE WILLIAM HEALTH SYSTEM 0 ROWAN HEALTH SERVICES CORP 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 561424814 HEALTHCARE NC 501(C)(3) 11C NOVANT HEALTH 0 NMG SERVICES INC (FKA ROWAN MEDICAL PRACTICES) 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 562098809 HEALTHCARE NC 501(C)(3) 9 ROWAN HEALTH SERVICES 0 ROWAN REGIONAL MEDICAL CENTER AUXILIARY 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 237022472 HEALTHCARE NC 501(C)(3) 9 ROWAN REGIONAL MEDICAL CENTER 0 ROWAN REGIONAL MEDICAL CENTER FOUNDATION INC 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 561424818 HEALTHCARE NC 501(C)(3) 7 ROWAN REGIONAL MEDICAL CENTER 0 ROWAN REGIONAL MEDICAL CENTER INC 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 560547479 HEALTHCARE NC 501(C)(3) 3 ROWAN HEALTH SERVICES 0 SELF INSURANCE FUND - NOVANT HEALTH INC 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 581867242 HEALTHCARE NC 501(C)(3) 11C NOVANT HEALTH 0 THE REHABILITATION INSTITUTE OF THE CAROLINAS 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 561665876 HEALTHCARE NC N/A RELATED 6055238 0 1 0.55000 SOUTHPARK SURGERY CENTER LLC 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 870714098 HEALTHCARE NC N/A RELATED 810110 4389647 0 1 0.60000 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 SOUTH PARK SURGERY CENTER P 3806602 COST SOUTH PARK SURGERY CENTER R 1219376 CASH THE REHABILITATION INSTITUTE OF THE CAROLINAS R 108181 CASH